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    题名 作者 年代 出处 被引量
1新疆地区气候与环境变化对沙尘暴的影响研究显示文摘根据新疆地区 5 0年来的气候变化以及人类活动的影响 ,阐述了新疆沙尘暴源区气候与荒漠环境变化。结果表明 ,新疆地区的气候由暖干向暖湿发展。自 2 0世纪 70年代中期以来 ,暖湿过程非常明显 ,特别是新疆南疆与北疆的气候变化特点和高山与盆地的气候变化差异以及湖泊其他水域面积的变化 ,都明显地反映了干旱区域气候变化的敏感性 ,并且也反映了新疆区域气候与中国中、东部气候变化的差异性。由于气候的波动和人类活动的干扰 ,使不同地区的荒漠环境受到不同程度影响。干旱地区的降水、大气湿度、下垫面状况等都直接影响着沙尘暴的发生和发展。沙尘暴的发生频率和强度与沙尘源区的状况及其气候与荒漠环境变化以及动力条件 (即天气系统 )等具有密切的关系。因此 ,2 0世纪 80年代后期以来 ,气候变暖是造成干旱区生态环境恶化、自然灾害尤其是风沙灾害和沙尘暴增多的主要原因之一。同时 ,也反映出内陆干旱区是气候变化的敏感反应区。魏文寿 高卫东 史玉光 Osamu ABE 2004干旱区地理2004,27,2:75
2含天然气水合物沉积物的岩石物性模型与似海底反射层的AVA特征显示文摘研究含天然气水合物沉积物的岩石物性模型与似海底反射层的振幅随入射角变化 (AVA)特征 .基于时间平均 -Wood加权方程、三相介质波传播理论模型和弹性模量模型 ,计算并阐述含天然气水合物岩石弹性参数与水合物饱和度、含游离气岩石弹性参数与游离气饱和度的关系 ;给出不同模型AVA特征 .结果表明 ,不同天然气水合物饱和度、不同游离气饱和度的各种组合呈现形态相似但反射系数值不同的AVA特征 .宋海斌 Matsubayashi Osamu 杨胜雄 吴能友 江为为 郝天珧 2002地球物理学报2002,45,4:48
3Endoscopic Kyoto classification of Helicobacter pylori infection and gastric cancer risk diagnosis显示文摘Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infection and evaluate gastric cancer risk.In 2013,the Japan Gastroenterological Endoscopy Society advocated the Kyoto classification,a new grading system for endoscopic gastritis.The Kyoto classification organized endoscopic findings related to H.pylori infection.The Kyoto classification score is the sum of scores for five endoscopic findings(atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness with or without regular arrangement of collecting venules)and ranges from 0 to 8.Atrophy,intestinal metaplasia,enlarged folds,and nodularity contribute to gastric cancer risk.Diffuse redness and regular arrangement of collecting venules are related to H.pylori infection status.In subjects without a history of H.pylori eradication,the infection rates in those with Kyoto scores of 0,1,and≥2 were 1.5%,45%,and 82%,respectively.A Kyoto classification score of 0 indicates no H.pylori infection.A Kyoto classification score of 2 or more indicates H.pylori infection.Kyoto classification scores of patients with and without gastric cancer were 4.8 and 3.8,respectively.A Kyoto classification score of 4 or more might indicate gastric cancer risk.Osamu Toyoshima Toshihiro Nishizawa Kazuhiko Koike 2020World Journal of Gastroenterology2020,26,5:44
4天然气水合物似海底反射层的全波形反演显示文摘建立了天然气水合物似海底反射层 (BSR)研究的全波形反演方法 .这是一种将水平层状弹性介质的反射共中心点道集转换为截距时间 -水平慢度域的反演方法 .反演过程中采用了全局搜索方法与非线性局部搜索方法 .分两步进行 .第一步是根据走时数据应用非常快速模拟算法求得速度结构的长波长分量 .第二步 ,利用波形资料用共轭梯度法求得速度的短波长扰动分量 .这样 ,最后反演得到的速度结构模型包含了长波长与短波长分量 .反演中利用了多网格参数化技术 .日本东南海海槽双BSR的速度结构的反演表明 ,全波形反演是天然气水合物BSR研究的重要手段之一 .宋海斌 Matsubayashi Osamu Kuramoto Shin’ichi 2003地球物理学报2003,46,1:40
5Analysis of aerodynamic and thermodynamic parameters on the grassy marshland surface of Tibetan PlateauTSUKAMOTO Osamu ISHIKAWA Hirohiko TAMAGAWA Ichiro 2002Progress in Natural Science:Materials International2002,12,1:34
6Causal role of Helicobacter pylori infection in gastric cancer显示文摘胃的癌症是在世界,为在亚洲的所有癌症盒子的一个大比例的财务,拉丁美洲,和在欧洲的一些国家上的第二很经常的癌症。Helicobacter pylori (H pylori ) 被认为是在萎缩性胃炎的发展起一个特定的作用,它多代表最公认的小径在走肠类型的胃的致癌作用。最近的研究建议那联合招待基因因素,细菌的毒力因素,并且环境并且生活方式因素决定胃的损坏和 H pylori 感染的最终的临床的结果的严厉。胃的癌症的领先的原因应该导致有效根除策略的 H pylori 的精液的发现。胃的癌症的预防要求更好屏蔽的策略为根除识别候选人。Takafumi Ando Yasuyuki Goto Osamu Maeda Osamu Watanabe Kazuhiro Ishiguro Hidemi Goto 2006World Journal of Gastroenterology2006,12,2:29
7Current role of ultrasound for the management of hepatocellular carcinoma显示文摘Hepatocellular carcinoma(HCC)has a decisive influence on the prognosis of cirrhotic patients.Although α-fetoprotein(AFP)is a known and specific tumor maker for HCC,it is not suitable for the screening and surveillance of HCC because of its poor predictive value and low sensitivity.The use of imaging modalities is essential for the screening,diagnosis and treatment of HCC.Ultrasound(US)plays a major role among them,because it provides realtime and non-invasive observation by a simple and easy technique.In addition, US-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of HCC.The development of digital technology has led to the detection of blood flow by color Doppler US, and the sensitivity for detecting tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents.Moreover,near real- time 3-dimensional US images are now available.As for the treatment of HCC,high intensity focused ultrasound (HIFU)was developed as a novel technology that provides a transcutaneous ablation effect without needle puncture.These advancements in the US field have led to rapid progress in HCC management,and continuing advances are expected.This article reviews the current application of US for HCC in clinical practice.Hitoshi Maruyama Masaharu Yoshikawa Osamu Yokosuka 2008World Journal of Gastroenterology2008,14,11:24
8Single-incision laparoscopic cholecystectomy:Single institution experience and literature review显示文摘Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.Yasumitsu Hirano Toru Watanabe Tsuneyuki Uchida Shuhei Yoshida Kanae Tawaraya Hideaki Kato Osamu Hosokawa 2010World Journal of Gastroenterology2010,16,2:23
9New Technologies and Systems for High Quality Citrus Fruit Production, Labor-saving and Orchard Construction in Mountain Areas of Japan显示文摘Novel technologies have been necessary for improving fruit quality and productivity of citrus, labor-saving and orchard conservation on steep slope lands since aging of growers and decrease in the number of successors is remarkable in mountain areas of southwestern Japan. The purpose of this paper is to introduce new technologies for improving citrus production that have been developed in recent years. A new fruit quality control system using drip irrigation and liquid fertilization technique combined with year-round plastic mulching was developed, and it enables high quality and stable citrus fruit production. Water and/or nutrient solution is automatically supplied through drip tubes that are laid under the mulching sheets to give adequate water stress, so as to improve sugar and acid content of fruit. A new transportation system for steep sloping citrus orchards, which is a combination of the monorail system and contour narrow paths, was suggested. A small walking cultivator was developed to explain the procedure of narrow path excavation. After introducing the narrow path, working hours for fertilizer and chemical herbicide application were reduced. Disaster prevention mapping of citrus orchards on slope lands was developed based on computer-aided seepage estimation and topographic data. The mapping can show zones of both ascending flow and descending flow of underground water during heavy rains in citrus orchards. The mapping is considered to be effective for the management of orchards and prevention of erosion on slope lands.Kunihisa MORINAGA Osamu SUMIKAWA Osamu KAWAMOTO Hiroyasu YOSHIKAWA Seiji NAKAO Masahiko SHIMAZAKI Shin-no-suke KUSABA Norihiro HOSHI 2005Journal of Mountain Science2005,2,1:21
10Nonalcoholic fatty liver disease and hepatic cirrhosis: comparison with viral hepatitis-associated steatosis显示文摘Nonalcoholic fatty liver disease(NAFLD) including nonalcoholic steatohepatitis(NASH) is globally increasing and has become a world-wide health problem. Chronic infection with hepatitis B virus or hepatitis C virus(HCV) is associated with hepatic steatosis. Viral hepatitis-associated hepatic steatosis is often caused by metabolic syndrome including obesity,type 2 diabetes mellitus and/or dyslipidemia. It has been reported that HCV genotype 3 exerts direct metabolic effects that lead to hepatic steatosis. In this review,the differences between NAFLD/NASH and viral hepatitis-associated steatosis are discussed.Yuki Haga Tatsuo Kanda Reina Sasaki Masato Nakamura Shingo Nakamoto Osamu Yokosuka 2015World Journal of Gastroenterology2015,21,46:20
11Importance of adequate immunosuppressive therapy for the recovery of patients with 'life-threatening' severe exacerbation of chronic hepatitis B显示文摘AIM: Hepatitis B virus (HBV) re-activation often occurs spontaneously or after withdrawal of immunosuppressive therapy in patients with chronic hepatitis B. Severe exacerbation, sometimes developing into fulminant hepatic failure, is at high risk of mortality. The efficacy of corticosteroid therapy in 'clinically severe' exacerbation of chronic hepatitis B has not been well demonstrated. In this study we evaluated the efficacy of early introduction of high-dose corticosteroid therapy in patients with lifethreatening severe exacerbation of chronic hepatitis B.METHODS: Twenty-two patients, 14 men and 8 women,were defined as 'severe' exacerbation of chronic hepatitis B using uniform criteria and enrolled in this study. Eleven patients were treated with corticosteroids at 60 mg or more daily with or without anti-viral drugs within 10 d after the diagnosis of severe disease ('early high-dose'group) and 11 patients were either treated more than 10 d or untreated with corticosteroids ('non-early high-dose'group).RESULTS: Mean age, male-to-female ratio, mean prothrombin time (PT) activity, alanine transaminase (ALT)level, total bilirubin level, positivity of HBeAg, mean IgMHBc titer, and mean HBV DNA polymerase activity did not differ between the two groups. Ten of 11 patients of the 'early high-dose' group survived, while only 2 of 11 patients of the 'non-early high-dose' group survived (P<0.001). During the first 2 wk after the introduction of corticosteroids, improvements in PT activities and total bilirubin levels were observed in the 'early high-dose'group. Both ALT levels and HBV DNA polymerase levels fell in both groups.CONCLUSION: The introduction of high-dose corticosteroid can reverse deterioration in patients with 'clinically lifethreatening' severe exacerbation of chronic hepatitis B,when used in the early stage of illness.Keiichi Fujiwara Osamu Yokosuka Hiroshige Kojima Tatsuo Kanda Hiromitsu Saisho Hiroyuki Hirasawa Hiroshi Suzuki 2005World Journal of Gastroenterology2005,11,8:20
12Improving recognition of hepatic perivascular epithelioid cell tumor:Case report and literature review显示文摘A 58-year-old man presented with the chief complaint of abdominal bloating and was incidentally found to have a liver tumor.As diagnostic imaging studies could not rule out malignancy,the patient underwent partial resection of segment 3 of the liver.The lesion pathologically showed eosinophilic proliferation,in addition to immunohistochemical positivity for human melanoma black 45 and Melan-A,thereby leading to the diagnosis of a hepatic perivascular epithelioid cell tumor(PEComa).A PEComa arising from the liver is relatively rare.Moreover,the name ‘PEComa' has not yet been widely recognized,and the same disease entity has been called epithelioid angiomyolipoma(EAML),further diminishing the recognition of PEComa.In addition,PEComa imaging findings mimic those of malignant liver tumors,and clinically,this tumor tends to enlarge.Therefore,a PEComa is difficult to diagnose.We conducted a systematic review of PEComa and EAML cases and discuss the results,including findings useful for differentiating perivascular epithelioid cell tumors from malignant liver tumors.Toshiya Maebayashi Katsumi Abe Takuya Aizawa Masakuni Sakaguchi Naoya Ishibashi Osamu Abe Tadatoshi Takayama Hisashi Nakayama Shunichi Matsuoka Kazushige Nirei Hitomi Nakamura Masahiro Ogawa Masahiko Sugitani 2015World Journal of Gastroenterology2015,21,17:20
13Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms显示文摘AIM: To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. METHODS: Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neoplasms in 25 enrolled patients were treated by endoscopic submucosal dissection. The therapeutic efficacy, complications, and follow-up results were assessed. RESULTS: The mean size of the lesions was 21 ± 13 mm (range 2-55 mm); the mean size of the resection specimens was 32 ± 12 mm (range 10-70 mm). The enblock resection rate was 100% (27/27), and en block resection with tumor-free lateral/basal margins was 88.9% (24/27). Perforation occurred in 1 patient who was managed by conservative medical treatments. None of the patients developed local recurrence or distant metastasis in the follow-up period. CONCLUSION: Endoscopic submucosal dissection is applicable to superficial esophageal squamous cell neoplasms with promising results.Kouichi Nonaka Shin Arai Keiko Ishikawa Masamitsu Nakao Yousuke Nakai Osamu Togawa Koji Nagata Michio Shimizu Yutaka Sasaki Hiroto Kita 2010World Journal of Gastrointestinal Endoscopy2010,2,2:19
14Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure显示文摘AIM: To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS: Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concentrations were measured before the procedure and 3, 6, and 24 h afterward. The frequency and severity of post-ERCP pancreatitis and the relationship between these phenomena and the change in amylase level were estimated. RESULTS: Post-ERCP pancreatitis occurred in 47 patients (3.6%). Pancreatitis occurred in 1% of patients with normal amylase levels 3 h after ERCP, and in 1%, 5%, 20%, 31% and 39% of patients with amylase levels elevated 1-2 times, 2-3 times, 3-5 times, 5-10 times and over 10 times the upper normal limit at 3 h after ERCP, respectively (level < 2 times vs ≥ 2 times, P < 0.001). Of the 143 patients with levels higher than the normal limit at 3 h after ERCP followed by elevation at 6 h, pancreatitis occurred in 26%. In contrast, pancreatitis occurred in 9% of 45 patients with a level higher than two times the normal limit at 3 h after ERCP followed by a decrease at 6 h (26% vs 9%, P < 0.05). CONCLUSION: Post-ERCP pancreatitis is frequently associated with an increase in serum amylase level greater than twice the normal limit at 3 h after ERCP with an elevation at 6 h. A decrease in amylase level at 6 h after ERCP suggests the unlikelihood of development of post-ERCP pancreatitis.Kei Ito Naotaka Fujita Yutaka Noda Go Kobayashi Jun Horaguchi Osamu Takasawa Takashi Obana 2007World Journal of Gastroenterology2007,13,28:19
15Gastric adenocarcinoma of fundic gland type with signet-ring cell carcinoma component: A case report and review of the literature显示文摘A depressed lesion was found at a gastric angle of 76-yearold Japanese woman by esophagogastroduodenoscopy. Four years prior, she was diagnosed with a Helicobacter pylori infection but no eradication was performed. The pathological diagnosis of biopsy specimens was signet-ring cell carcinoma. Endoscopic submucosal dissection(ESD) was performed. Histopathological examination of the ESD specimen revealed proliferation of well-differentiated tubular adenocarcinoma mimicking fundic gland cells at the deep layer of the lamina propria mucosae. These tumor cells expressed focally pepsinogen-Ⅰ, diffusely MUC6, and scattered H^+/K^+ ATPase according to immunohistochemistry. Therefore, we diagnosed this tumor as gastric adenocarcinoma of fundic gland type(GA-FG). Adjacent to the GA-FG, proliferation of signet-ring cell carcinoma which diffusely expressed MUC 2 and MUC 5AC was observed. Intestinal metaplasia was focally observed in the surrounding mucosa of the signet-ring cell carcinoma. To the best of our knowledge, this is the first case report of GA-FG with a signet-ring cell carcinoma component. The origin of signet-ring cell carcinoma, i.e., whether it accidentally arose from a non-neoplastic mucosa and coexisted with the GA-FG or dedifferentiated from the GA-FG is unclear at present. We expect the accumulation of similar cases and further analysis to clarify this issue.Keita Kai Masaaki Satake Osamu Tokunaga 2018World Journal of Gastroenterology2018,24,26:19
16Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction显示文摘AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent(PS) or nasobiliary catheter(NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedurerelated adverse events, stent/catheter dysfunction(occlusion or migration of PS/NBC, developmentof cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution(bilirubin level < 3.0 mg/d L) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.RESULTS: In total, 419 patients were included in the study(PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients(46%), bile duct cancer in 172(41%), gallbladder cancer in three(1%), and ampullary cancer in 50(12%). The median serum total bilirubin was 7.8 mg/d L and 324 patients(77%) had ≥ 3.0 mg/d L. During the median time to surgery of 29 d [interquartile range(IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio(SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method(PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.Naoki Sasahira Tsuyoshi Hamada Osamu Togawa Ryuichi Yamamoto Tomohisa Iwai Kiichi Tamada Yoshiaki Kawaguchi Kenji Shimura Takero Koike Yu Yoshida Kazuya Sugimori Shomei Ryozawa Toshiharu Kakimoto Ko Nishikawa Katsuya Kitamura Tsunao Imamura Masafumi Mizuide Nobuo Toda Iruru Maetani Yuji Sakai Takao Itoi Masatsugu Nagahama Yousuke Nakai Hiroyuki Isayama 2016World Journal of Gastroenterology2016,22,14:18
17Interleukin-17 levels in Helicobacter pylori-infected gastric mucosa and pathologic sequelae of colonization显示文摘AIM: To determine the role of interleukin (IL)-17 in gastric ulcerogenesis. METHODS: Thirty-six gastric ulcer (GU) patients and 29 non-ulcer (NU) patients were enrolled in this study. Mucosal biopsy samples were obtained from the gastric antrum and GU site during endoscopy. Samples were used in in situ stimulation for 48 h in the presence of 10 μg/mL phytohemagglutinin-P (PHA), histological examination, and Helicobacter pylori(H pylori) culture. IL-17 and IL-8 protein levels in culture supernatants were assayed by ELISA. IL-17 mRNA expression was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). H pylori cagA and vacA status was assessed by reverse hybridization using a line probe assay (LiPA). IL-8 levels in culture supernatants were assayed after AGS cells were co-cultured with H pylori strain 26 695 or recombinant human (rh) IL-17. RESULTS: All 36 GU patients and 15 of 29 NU patients were found to be H pylori-positive, while 14 NU patients were H pylori-negative. All 51 H pylori strains from both GU and NU patients were cagA- and vacAs1/m1-positive. Antral mucosal tissues from H pylori-positive patients contained significantly (H pylori-positive NU patients: median 467 pg/mg/protein, range 53-2 499; H pylori-negative NU patients: median 104 pg/mg/protein, range 16-312, P<0.0005) higher levels of IL-17 than those from uninfected patients. IL-17 levels at the ulcer site were significantly (ulcer site: median 1356 pg/mg/protein, range 121-1 3730; antrum: median 761 pg/mg/protein, range 24-7 620, P<0.005) higher than those at distant sites in the antrum. Biopsies from H pylori-positive GU and NU patients showed IL-17 mRNA expression in all samples whereas those from the antrum of the H pylori-negative controls showed no detectable expression. A significant correlation was seen between IL-17 and IL-8 levels at each biopsy site (ulcer: r= 0.62, P<0.0001; antrum: r = 0.61, P<0.0001) in GU patients. RhIL-17 and H pylori strain 26 695 each stimulated IL-8 production from AGS cells. CONCLUSION: IL-17 may play an important role in the inflammatory response to H pylori colonization, and may ultimately influence the outcome of H pylori-associated diseases that arise within the context of gastritis.Tomokazu Mizuno Takafumi Ando Kazuo Nobata Tomoyuki Tsuzuki Osamu Maeda Osamu Watanabe Masaaki Minami Kenji Ina Kazuo Kusugami Richard M. Peek Hidemi Goto 2005World Journal of Gastroenterology2005,11,40:18
18Laparoscopy in the management of hilar cholangiocarcinoma显示文摘The use of minimally invasive surgery has become widely accepted in many gastrointestinal fields,even in patients with malignancy.However,performing laparoscopic resection for the treatment of hilar cholangiocarcinoma is still not universally accepted as an alternative approach to open surgery,and only a limited number of such procedures have been reporteddue to the difficulty of performing oncologic resection and the lack of consensus regarding the adequacy of this approach.Laparoscopy was initially limited to staging,biopsy and palliation.Recent technological developments and improvements in endoscopic procedures have greatly expanded the applications of laparoscopic liver resection and lymphadenectomy,and some reports have described the use of laparoscopic or robot-assisted laparoscopic resection for hilar cholangiocarcinoma as being feasible and safe in highly selected cases,with the ability to obtain an adequate surgical margin.However,the benefits of major laparoscopic surgery have yet to be conclusively proven,and carefully selecting patients is essential for successfully performing this procedure.Akihiro Cho Hiroshi Yamamoto Osamu Kainuma Yorihiko Muto Hiroo Yanagibashi Toru Tonooka Takahito Masuda 2014World Journal of Gastroenterology2014,20,41:18
19Antiviral therapies for chronic hepatitis C virus infection with cirrhosis显示文摘Patients who are infected with hepatitis C virus(HCV) and also have advanced fibrosis or cirrhosis have beenrecognized as 'difficult-to-treat' patients during an era when peginterferon and ribavirin combination therapy is the standard of care. Recent guidelines have clearly stated that treatment should be prioritized in this population to prevent complications such as decompensation and hepatocellular carcinoma. Recent advances in the treatment of chronic hepatitis C have been achieved through the development of direct-acting antiviral agents(DAAs). Boceprevir and telaprevir are first-generation DAAs that inhibit the HCV NS3/4A protease. Boceprevir or telaprevir, in combination with peginterferon and ribavirin, improved the sustained virological response rates compared with peginterferon and ribavirin alone and were tolerated in patients with HCV genotype 1 infection without cirrhosis or compensated cirrhosis. However, the efficacy is lower especially in prior non-responders with or without cirrhosis. Furthermore, a high incidence of adverse events was observed in patients with advanced liver disease, including cirrhosis, in real-life settings. Current guidelines in the United States and in some European countries no longer recommend these regimens for the treatment of HCV. Next-generation DAAs include second-generation HCV NS3/4A protease inhibitors, HCV NS5 A inhibitors and HCV NS5 B inhibitors, which have a high efficacy and a lower toxicity. These drugs are used in interferon-free or in interferon-based regimens with or without ribavirin in combination with different classes of DAAs. Interferon-based regimens, such as simeprevir in combination with peginterferon and ribavirin, are well tolerated and are highly effective especially in treatmentnave patients and in patients who received treatment but who relapsed. The efficacy is less pronounced in nullresponders and in patients with cirrhosis. Interferonfree regimens in combination with ribavirin and/or two or more DAAs could be used for treatment-nave, treatment-experienced and even for interferon-ineligible or interferon-intolerant patients. Some clinical trials have demonstrated promising results, and have shown that the efficacy and safety were not different between patients with and without cirrhosis. There are also promising regimens for genotypes other than genotype 1. Interferonis contraindicated in patients with decompensated cirrhosis, and further studies are needed to establish the optimal treatment regimen for this population. In the future, interferon-free and ribavirin-free regimens with high efficacy and improved safety are expected for HCVinfected patients with advanced liver diseases.Shingo Nakamoto Tatsuo Kanda Hiroshi Shirasawa Osamu Yokosuka 2015World Journal of Hepatology2015,7,8:17
20Current and future directions for treating hepatitis B virus infection显示文摘Hepatitis B virus(HBV) persistently infects approximately 350 million people, and approximately 600000 liverrelated deaths are observed per year worldwide. HBV infection is also one of the major risk factors for hepatocellular carcinoma(HCC). The persistence of serum hepatitis B e antigen(HBe Ag) and high level of serum HBV DNA are thought to reflect a high HBV replication status in hepatocytes, causing cirrhosis, HCC and liver-related deaths. It has been reported that antiviral therapy, such as peginterferon and nucleos(t)ide analogues(NUCs), could suppress liver-related death by inhibiting the HBV DNA levels and inducing seroconversion from HBe Ag to antibody to HBe antigen. Currently, peginterferon is widely used, but there are also several disadvantages in the use of peginterferon, such as various adverse events, the administration route and duration. It is difficult to predict the effects of treatment and interferon is contraindicated for the patients with advanced fibrosis of the liver and cirrhosis. With respect to NUCs, entecavir and tenofovir disoproxil fumarate are current the first-choice drugs. NUCs can be administered orally, and their anti-viral effects are stronger than that of peginterferon. However, because cessation of NUC administration leads to high levels of viral replication and causes severe hepatitis, they must be administered for a long time. On the other hand, the use of both interferon and NUCs cannot eliminate covalently closed circular DNA of HBV. In this review, we evaluate the natural course of chronic HBV infection and then provide an outline of these representative drugs, such as peginterferon, entecavir and tenofovir disoproxil fumarate.Akinobu Tawada Tatsuo Kanda Osamu Yokosuka 2015World Journal of Hepatology2015,7,11:16
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